Effect of Anterior Capsule Polishing on the Capsule-IOL Complex in Patients With Normal Axial Length: A Prospective Randomized Controlled Trial.

PURPOSE: To evaluate the effect of anterior capsule polishing (ACP) on postoperative formation of the capsule-intraocular lens (C-IOL) complex in patients with cataract who have normal axial length.

METHODS

In this prospective randomized controlled trial, patients were assigned to either 360° ACP or no polishing. Primary outcomes (capsular bend index [CBI], adhesion index [AI], and continuous curvilinear capsulorhexis diameter [CCCD]) and secondary outcomes (IOL tilt and decentration) were quantitatively assessed at 1 week, 1 month, and 3 months postoperatively using 14-meridian swept-source optical coherence tomography (SS-OCT) (CASIA 2; Tomey). Additional secondary outcomes were root mean square (RMS), corrected distance visual acuity (CDVA), and spherical equivalent refraction (SER).

RESULTS

Forty-five eyes were enrolled (23 ACP, 22 control), and 40 (20 per group) completed a 3-month follow-up. At 3 months, the ACP group showed lower CBI (3.16 vs 3.68; P = .001) and AI (0.00 vs 0.32; P = .023), larger CCCD (5.30 vs 5.04 mm; P = .025), and less CCCD contraction (0.11 vs 0.22 mm; P = .034). Between-visit changes in CBI and AI did not differ between groups. Vertical tilt and its RMS were greater with ACP (P = .012 and .009, respectively), whereas horizontal tilt, decentration, CDVA, and SER were comparable.

CONCLUSIONS

ACP slows early C-IOL structural maturation (reduced capsular-bend kinetics and delayed capsule-IOL adhesion) without compromising early refractive stability and stabilizes the capsulorhexis, but increases vertical IOL tilt. These findings support selective use in eyes prone to contraction and caution when precise IOL alignment is required.